Health care system of myanmar 28 8-2016
- 1. Dr.Htet Ko Ko Aung Dr.Thu Naing Dr.Han Tun Khaing Dr.Lynn Thet Su Mon Presented by
- 2. Outline Myanmar - General Profile Health System Profile of MYANMAR Current Status of MYANMAR Health System Success story in health system
- 3. Myanmar / Burma THE REPUBLIC OF UNION OF MYANMAR Second largest country in Southeast Asia region Total population - 51,419,420 (5th in ASEAN Region) 70 % of population live in Rural areas Literacy rate - 89.5 % (7th in ASEAN) Culture – Religion – Buddhism (87 %) Life expectancy at birth – 66.8 % (9th in ASEAN) Crude birth rate (per 1,000) = 17.8 Crude death rate (per 1,000) = 8.25 In 2015 GDP $ 64.87 billion GDP per capita 1200 $ GDP growth 7.0% Inflation 10.8%
- 4. 1420 1110 1200 1200 10500 10700 10800 10000 0 2000 4000 6000 8000 10000 12000 2012 2013 2014 2015 GDPperCapita,Dollars Years GDP per capita in Myanmar Dollars 2012-2015 GDP per capita dollars Myanmar GDP per capita dollars World Source: http://data.worldbank.org
- 5. 0 2000 4000 6000 8000 10000 12000 2012 2013 2014 2015 GDPPERCAPITA,DOLLARS YEARS GDP per capita in Myanmar and ASEAN Dollars 2012-2015 GDP per capita dollars Myanmar GDP per capita dollars Malasyia GDP per capita dollars Cambodia GDP per capita dollars Thailand GDP per capita dollars Vietnam GDP per capita dollars Indonesia GDP per capita dollars Phillipine Source: http://data.worldbank.org
- 6. The colonial period (1886–1948) • Inherited the health system introduced by the British • The focus of the colonial medical department was hospital care, vaccination against communicable diseases and sanitation. • doctors were non-native as few natives were ready to take the long and arduous medical course. • Most doctors were concentrated in towns and most of the population continued • to seek health care from indigenous medical practitioners and traditional birth attendants in the villages The parliamentary period (1948–1962) The BSPP period (1962–1988) The SLORC and SPDC period (1988–2011) The democratization period (2011 to date) Historical background Source: Myanmar Health system review 2014
- 7. The colonial period (1886–1948) The parliamentary period (1948–1962) The BSPP period (1962–1988) The SLORC and SPDC period (1988–2011) • Trained foreign medical and other health personnel were terminated. • After independence, the public health sector was reoriented to a socialist style of welfare. • A rural health scheme was initiated in 1951 with the establishment of a Health Assistant Training School in Rangoon (Yangon) • Key parts of the health sector, such as Women and Child Welfare and Child Health Services, were set up as a separate directorate which were unified into a single directorate called the Directorate of Health Services. The democratization period (2011 to date) Historical background Source: Myanmar Health system review 2014
- 8. The colonial period (1886–1948) The parliamentary period (1948–1962) The BSPP period (1962– 1988) The SLORC and SPDC period (1988–2011) The democratization period (2011 to date) First major reforms in the health sector, designed to achieve universal health care. In order to implement primary health care (PHC), the BSPP introduced voluntary health workers – Community Health Workers (CHWs) and Auxiliary Midwives (AMWs). Historical background Source: Myanmar Health system review 2014
- 9. The colonial period (1886–1948) The parliamentary period (1948–1962) The BSPP period (1962–1988) The SLORC and SPDC period (1988–2011) The democratization period (2011 to date) National Health Committee (NHC) was formed. Emphasis on expanding health services to the border areas. Community Cost Sharing (CCS) scheme to increase community participation was introduced. Historical background Source: Myanmar Health system review 2014
- 10. The colonial period (1886–1948) The parliamentary period (1948–1962) The BSPP period (1962–1988) The SLORC and SPDC period (1988–2011) The democratization period (2011 to date) Myanmar entered a new political phase. Expenditure for health was raised considerably in 2012–2013. Community Cost Sharing (CCS) scheme is still in place. The government provides some coverage for the poor through Hospital Trust Funds. Historical background Source: Myanmar Health system review 2014
- 11. Two main objectives of Ministry of Health and Sports “Enabling every citizen to attain full life expectancy and enjoy longevity of life” “ensuring that every citizen is free from diseases”
- 12. Organogram of Ministry of Health and Sports (MOHS) THE REPUBLIC OF THE UNION OF MYANMAR Department of Health professional and resource development Department of Traditional medicine Department of Medical service Department of Public Health Department of Medical research Department of sport and physical education Department of Food and Drug administration Ministry of Health and Sports Source: http://www.moh.gov.mm/
- 13. Health service delivery system in Myanmar (36) 500-& 1000- bed specialist hospitals (81) 100-, 150-, 200-& 300- bed district/ region/state hospitals (65) 50-bed township hospitals (190) 25-bed Township hospitals (572) 16-bed station hospitals Hospital care Primary Curative care Secondary Curative care Tertiary Curative care Source: Myanmar Health system review 2014
- 14. Health service delivery system in Myanmar (7581) Sub-RHCs (1635) RHCs (87) Urban HCs (348) MCH centers Ambulatory care Source: Myanmar Health system review 2014
- 15. Sr. Causes Percentage 1 Injuries 10.0 2 Complication of pregnancy and delivery 6.9 3 Single spontaneous delivery 6.0 4 Diarrhoea and gastroenteritis of presumed infectious origin 5.8 5 Other viral diseases 3.8 6 Other pregnancies with abortive outcome 2.6 7 Gastritis and duodenitis 2.4 8 Malaria 2.4 9 Cataract and other disorders of lens 2.4 10 Other acute upper respiratory infections 2.0 Figure : (1) Single Leading Causes of Morbidity (2012) Health in Myanmar-2014
- 16. Sr. Causes Percentage 1 Human immunodeficiency virus (HIV) disease 6.6 2 Septicaemia 6.1 3 Other injuries of specified, unspecified and multiple body regions 5.4 4 Slow fetal growth, fetal malnutrition and disorders related to short gestation and low birth weight 4.6 5 Other diseases of liver 4.0 6 Other diseases of the respiratory system 3.7 7 Intrauterine hypoxia and birth asphyxia 3.4 8 Heart failure 3.3 9 Respiratory tuberculosis 3.2 10 Intracranial haemorrhage 2.9 Figure : (2) Single Leading Causes of Mortality (2012) Health in Myanmar-2014
- 17. 237 226 218 210 205 201 195 189 184 178 0 50 100 150 200 250 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 MMRPER100,000LIVEBIRTH YEAR Maternal Mortality Ratio (MMR) Source: http://data.worldbank.org MDG target 150 Figure(3) : Maternal Mortality Ratio
- 18. 32.8 32.1 31.7 30.5 29.7 29 28.4 27.7 27 26.4 0 5 10 15 20 25 30 35 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Neonatalmortalityrate(per1000live births) Years Neonatal mortality rate (per 1000 live births) Source: http://apps.who.int/gho/data/node.country.country-MMR Figure(4) : Neonatal Mortality Rate
- 19. 51.7 50.2 53.4 47.3 45.8 44.5 43.2 41.9 40.7 39.5 0 10 20 30 40 50 60 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 INFANTMORTALITYRATE(PER 1000POP) YEARS Infant Mortlity Rate Source: http://data.worldbank.org Figure(5) : Infant Mortality Rate
- 20. 68.1 65.8 87.2 61.4 59.3 57.2 55.3 53.5 51.7 50 0 10 20 30 40 50 60 70 80 90 100 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 U5MR(per1,000livebirths) Years Under-5 Mortality rate (per 1,000 live births) Myanmar 2006- 2015 Source: http://data.worldbank.org MDG target 37 Figure(6) : Under-5 Mortality Rate
- 21. 63.1 63.9 64.6 68.2 70.6 73 74.3 74.8 82 80 0 10 20 30 40 50 60 70 80 90 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 ANCcoverage(%) Years ANC coverage in Myanmar 2006-2015 Source: Health in Myanmar 2015 Figure(7) : ANC Coverage in Myanmar
- 22. Figure (8) : National Immunization Coverage of Myanmar (1980-2014) 1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 2014 BCG 9 45 95 90 88 76 93 93 87 86 86 DPT 3 4 16 88 84 82 73 90 84 84 75 75 OPV 3 3 88 84 88 86 90 90 87 76 76 MCV 1 68 82 84 84 88 88 84 86 86 0 20 40 60 80 100 %Coverage Source: WHO/UNICEF coverage estimates
- 23. Figure(9): HIV Situation in Myanmar Source: who.int/gho/hiv/en
- 24. Figure(10): Number of people living with HIV in Myanmar- 2015 Source: http://aidsinfo.unaids.org
- 25. TB Situation in Myanmar • Myanmar is one of the 30 high burden countries for TB, TB/HIV, MDRTB. Source: Use of high burden country lists for TB by WHO in the post-2015 era
- 26. Figure(11,12,13) : TB epidemiology, Myanmar (2014) Incidence Mortality Prevalence Data source: Global TB report (2015)
- 27. Figure(14) : Confirmed Malaria Cases per 1000 population/Parasite Prevalence 2014 in SEAR Source: Global Malaria Report 2014
- 28. Figure(15): Trend of Malaria Morbidity and Mortality Rate in Myanmar (1990-2013) Source: Health in Myanmar 2014
- 29. Figure (16): Proportional Mortality (% of Total death, all ages, both sexes) Communicable , Maternal, Perinatal, and Nutritional Conditions 30% Injuries 11% Cardiovascular Diseases 25 % Cancer 11% Chronic respiratory diseases Other NCDs 11% Diabetes 3% NCDs are estimated to account for 59% of total deaths. Total Deaths : 441,000 Data Source : WHO : Non-communicable diseases Country profile - 2014
- 30. According to WHO data, the probability of dying between ages 30 and 70 years from 4 main NCDs are – 1. Cardiovascular 25 % 2. Cancer – 11 % 3. Chronic Respiratory Diseases – 9 % and 4. Diabetes – 3 % 24 %
- 31. Figure (17) : Health Financing : Myanmar Health Expenditure • The major sources of finance for health services are the government. • Out of pocket expenditure is the main source of finance. • Government has increased health expenditure yearly. Source: Health in Myanmar 2014
- 32. Figure (18) : Health Expenditure by Total GDP of Myanmar VS Other Countries from 2010-2014 4.02 3.89 4.16 4.21 4.27 3.06 3.16 3.08 2.88 2.82 1.92 1.87 2.22 2.16 2.28 6.43 6.73 5.89 5.69 5.805.41 5.91 6.16 6.18 6.53 0 1 2 3 4 5 6 7 8 2010 2011 2012 2013 2014 %ofHealthExpenditurebyTotalGDP Year ASEAN Bangladesh Myanmar Nepal Thailand Source: www.data.worldbank.org
- 33. Health Insurance Myanmar government officially announced that the nation-wide health insurance policies as of July 1, 2015. State-owned Myanmar Insurance and 11 private domestic companies will offer identical policies. Eligible - Myanmar citizens and foreign nationals residing in the country - 6 to 65 years -in good health Can buy the insurance of between one to five units of coverage (one unit costs approximately 50 USD) Benefits -approximately 15 USD per day of hospitalization per unit. (30 days per year) -dies in hospital, their designated beneficiary will receive compensation (~1,000 USD per unit). Source: Health Care in Myanmar, Nagoya J. Med. Sci. 78. 123 ~ 134, 2016
- 34. Social security scheme 1954 Social Security Act by the Ministry of Labor. Factories, workshops and enterprises that have over 5 employees whether state owned, private, foreign or joint ventures, must provide the insurance for their employees with social security cover. Benefits: free medical treatment, cash benefits and occupational injury benefit. Workers’ hospitals, dispensaries, mobile medical units and branch offices have been established nation- wide. The 2012 Social Security Law was enacted on 31 August 2012. In this new law, invalidity, old age pension benefit, survivors’ benefit and unemployment benefit systems have been introduced based on international practice. Employer 2.5% Government (Capital investment) Employee 1.5% Source: Health in Myanmar 2014
- 35. Figure (19) : Health Facilities in Myanmar Sr. Health Manpower 2013-2014 1 Curative and rehabilitative services 1056 General hospitals (up to 2,000 beds) 4 Specialist hospitals (100–1,200 beds) 50 State/district hospitals (200–500 beds) 55 Township hospitals (25–100 beds) 330 Station hospital (16–25 beds) 617 2 Preventive and public health services 2199 Primary and secondary health centers 87 Maternal and child health centers 348 Rural health centers 80 School health teams 3467 3 Traditional medicine 259 Traditional medicine hospitals 16 Traditional medicine clinics 243
- 36. Figure (20) : Health Care Professional in Myanmar Sr. Health Manpower 2013-2014 1 Medical doctor 31542 Public 13099 Co-operative and private 18443 2 Dentist 3219 Public 782 Co-operative and private 2437 3 Health Assistant 2062 4 Nurse 29532 5 Dental nurse 357 6 Midwife 21435 7 Lady Health Visitor 3467 8 Health Supervisor(1) 652 9 Health Supervisor (2) 4998 10 Traditional Medicine Practitioner 6963 Public 1048 Private 5915
- 37. Figure (21) : Health Work Force at National Level (2006/2007) and (2010/2011) 0 0.1 0.2 0.3 0.4 0.5 0.6 Doctor Dental surgeon Health assistant Nurse Midwife HW/1000POPULATION 2006/2007 2010/2011 Source: Myanmar health system review 2014
- 38. Health information system strategic plan, HISSP (2011-2015) 1st strategic plan for Health Information System Before that, WHO biannual workplan (or) Annual workplan supported by UNICEF (or) UNFPA on a yearly basis At 2006, Assessment for current HIS and reviewed in 2009 Development of HISSP – begin in 2009 and finalized at 2010
- 39. Assessment of Six components of HIS System Category Score • Resources (Policy, Planning, Institutions, HR & Financing, Infrastructure) 52 % • Indicators 66 % • Data sources (Census, Vital Statistics, Population based surveys, Health & diseases Records, Health services records, Administrative records) 49 % • Data Management 45 % • Information Products (Mortality, Morbidity, Health System, Data collection methods – timeliness, periodicity, consistency, representation, Disaggregation, Estimation Method ) 64 % • Dissemination and Use (Analysis and use of information, Policy and advocacy, Planning and Priority setting, Resource allocation, Implementation) 52 %
- 40. Success Story • Malaria is one of the priority diseases in Myanmar. • Malaria is endemic in 284 out of 330 townships in Myanmar.
- 41. Malaria Control Program in Myanmar Specific Objectives 1. To reduce malaria morbidity and mortality by 60% in 2016. (baseline 2009) 2. To contribute socioeconomic development and achievement of health related MDG in 2015.
- 42. Activities of Malaria Control Program 1. Information, Education and Communication Dissemination of messages through various media channels -regular use of bed nets (appropriate use of insecticide treated nets) -early (ASAP within 24 hours after onset of fever) seeking of quality diagnosis and appropriate treatment. Production and distribution of IEC materials -different local languages for various ethnic and different target groups Advocacy activities are conducted at different levels.
- 43. 2. Preventive activities Stratification of Areas for Malaria Control Malaria area Micro-stratification up to village level was done in 180 townships. Effective resource allocation
- 44. 2. Preventive activities- cont. Insecticide Treated Mosquito Nets ITN Program (area prioritization) distribution of Long Lasting Insecticidal Nets (LLIN) or impregnation of existing nets. 788,866 LLINs were distributed and 638466 existing bed nets were impregnated in 2013. Epidemic preparedness and response Ecological surveillance and community based surveillance One disastrous epidemic in 2001 was estimated to have caused nearly 1,000 deaths. Number of outbreaks decreased during last five years. No malaria outbreak was reported in 2007, 2012 and 2013.
- 45. 3. Early diagnosis and Appropriate treatment Case management with ACT (Artemisinin based combination therapy) was practiced in all 330 townships. Malaria mobile teams Community based Malaria Control Program in total 182 townships malaria voluntary health workers (3875 volunteers were trained in 2013)
- 46. 4. Capacity building Trainings and Refresher trainings Different categories of 6000 health care providers were trained especially on trained on different technical areas.
- 48. Trend of Malaria Morbidity and Mortality Rate in Myanmar (1990-2013) Source: Health in Myanmar 2014
- 49. • It is a remaining public health problem due to climatic and ecological changes and the economic development activities and development of multi-drug resistant P. falciparum parasite.
Editor's Notes
- #5: GDP = To see how the nationals of a country are doing economically. GNP = An estimated value of the total worth of production and services, by citizens of a country, on its land or on foreign land, calculated over the course on one year. GDP = consumption + investment + (government spending) + (exports − imports). GNP = GDP + NR (Net income inflow from assets abroad or Net Income Receipts) - NP (Net payment outflow to foreign assets). Uses = Business, Economic Forecasting (GDP) Business, Economic Forecasting (GNP) To see the strength of a country’s local economy (GDP) To see how the nationals of a country are doing economically. (GNP)
- #32: Current-service fees, medicine Capital- infrastructure and assets